The amount the NHS spends per patient will fall by at least £98 by 2020 under funding pledges made by each of the main political parties, figures based on NHS England’s internal calculations reveal.

The figures show that despite the current “ring fence” which protects the NHS budget in England from inflation, spending measured on health officials’ preferred measure – estimated patient numbers, which take account of the fact that as people age, they get sicker – has already dropped by £50 per patient since 2009. Read more

This stems from health secretary Andrew Lansley’s recent comment that “age is the principal determinant of health need” and that distribution of the £100bn budget for the NHS in England should “get progressively to a greater focus on what are the actual determinants of health need.”

It’s a good story, which might even contain elements of the truth, but the reality, as ever, is a little more complicated.

At present, five separate allocation formulae are used to divvy up different bits of the £100bn NHS pot to different areas of England. The largest share – the hospital care budget – is divided up using one formula, while four others – mental health, GP prescribing, health inequalities (more on that in a later post) and maternity – are each allocated using their own separate formula. (Think for a second about the demographics driving the demand for maternity services as opposed to, say, hip replacements, and you will grasp why this makes sense.)

Health economists and statisticians frequently tweak and argue over these formula in order to move, hopefully, ever closer to the Holy Grail: a distribution of health resources which is fairly distributed on the basis of health need. Read more